5455M2DB

54-DB-5-1

Based on current scientific evidence, I am in favor of continued fluoridation of the U.S. water supply. As of 2018, the Centers for Disease Control and Prevention (CDC) supports community water fluoridation as an effective, safe, and cost-saving intervention (CDC, 2018).

I am acutely aware and agree with CDC’s statement that

profound disparities in oral health status remain for some population subgroups, such as the poor, the elderly, and many members of racial and ethnic minority groups. Tooth decay is one of the most common chronic diseases among American children with 1 of 4 children living below the federal poverty level experiencing untreated tooth decay (CDC, 2018).

The area in which I live, the Northern Virginia/Washington DC Metropolitan area, has programs available for school-aged children who require dental care; however, no such programs to my knowledge exist for adults (I know there are efforts in rural areas that to great work). Arguably, dental caries is an even greater burden on working adults; anecdotally, poor dental hygiene can hinder employment prospects and the high cost of dental care for even the insured can cause financial hardships for socioeconomically disadvantaged groups. Public health has, in my opinion, an outsized obligation to care for and design services and structural elements for these groups. Diseases and disorders of all kinds affect and impact socioeconomic minorities and disadvantaged populations and fluoridation provides an effective and cost-effective tool to prevent dental caries. There is a reason that CDC considers community water fluoridation one of its top ten greatest public health achievements of the 20th century (CDC, 1999).

However, I am in favor of revisiting the recommended fluoride concentration in community drinking water. Although the U.S. Public Health Service (PHS) updated its recommendations on the optimal fluoride concentration from 0.7 – 1.2 mg/L as established in its 1962 Drinking Water Standards to 0.7 mg/L in 2015 (U.S. Department of health and Human Services Federal Panel on Community Water Fluoridation, 2015), there is a growing body of literature that suggests that even this lower concentration may be higher than necessary and/or fluoridation of drinking water as a suboptimal method of preventing dental caries (Peckham & Awofeso, 2014). The City of Alexandria, Virginia where I am a resident, has a water fluoridation level of 0.7 mg/L, which follows PHS guidelines (CDC, n.d.), with an actual measured average of 0.6 mg/L up to a high of 0.8 mg/L (Virginia American Water, 2017), which is well below the Environmental Protection Agency (EPA) maximum containment level of 4 mg/L (EPA, 2018).

References

Peckham, S. & Awofeso, N. (2014). Water Fluoridation: A Critical Review of the Physiological Effects of Ingested Fluoride as a Public Health Intervention. The Scientific World Journal. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3956646/

U.S. Centers for Disease Control and Prevention. (1999). Achievements in public health, 1900-1999: fluoridation of drinking water to prevent dental caries. Morbidity and Mortality Weekly Report, 48(41), 933-940.

U.S. Centers for Disease Control and Prevention. (n.d.). Public Water System Details. Retrieved from https://nccd.cdc.gov/DOH_MWF/Default/WaterSystemDetails.aspx

U.S. Department of Health and Human Services Federal Panel on Community Water Fluoridation. (2015). U.S. Public Health Service Recommendation for Fluoride Concentration in Drinking Water for the Prevention of Dental Caries. Public Health Reports, 130(4), 318-331.

U.S. Environmental Protection Agency. (2018). National Primary Drinking Water Regulations. Retrieved from https://www.epa.gov/ground-water-and-drinking-water/national-primary-drinking-water-regulations

Virginia American Water. (2017). 2017 Annual Water Quality Report: Alexandria District. Retrieved from http://www.amwater.com/ccr/alexandria.pdf